Prof. Qin Ning (宁琴宁琴), MD. PHD Department of Infectious Disease, Tongji HospitalDepartment of Infectious Disease, Tongji HospitalIntroduction to Infectious DiseasesIntroduction to Infectious Diseases TONGJI MEDICAL COLLEGETONGJI MEDICAL COLLEGETONGJI MEDICAL COLLEGE HUAZHONG UNIVERSITY OF SCIENCE & TECHNOLOGYHUAZHONG UNIVERSITY OF SCIENCE & TECHNOLOGYHUAZHONG UNIVERSITY OF SCIENCE & TECHNOLOGY1传染病学绪论华中科技大学同济医学院What is an Infectious What is an Infectious Disease?Disease?Infectious DiseasesInfectious DiseasesInfectious Diseases - caused by human - caused by human - caused by human infection of micro-organisms and parasites infection of micro-organisms and parasites infection of micro-organisms and parasites InfectionInfectionInfection - the ability of an organism to - the ability of an organism to - the ability of an organism to invade and establish itself in a hostinvade and establish itself in a hostinvade and establish itself in a hostCommunicable InfectionCommunicable InfectionCommunicable Infection - a disease that is - a disease that is - a disease that is transmitted from person to anothertransmitted from person to anothertransmitted from person to another2传染病学绪论华中科技大学同济医学院What is an Infectious Disease?n nMicroorganismsMicroorganismsn nBacteriaBacterian nVirusVirusn nPrion(Prion(盶毒体盶毒体) )n nFungusFungusn nProtozoa(Protozoa(原虫原虫) )n nHelminth(Helminth(蠕虫蠕虫) )n nProductsfrommicroorganismsProductsfrommicroorganismsn ntoxinstoxins3传染病学绪论华中科技大学同济医学院Current Situation Increasingly serious threats from Communicable diseasesRe-emerging:TB(Re-emerging:TB(结核结核),STD,plague(),STD,plague(瘟疫瘟疫),cholera(),cholera(霍乱霍乱)Emerging:AIDS,SARSEmerging:AIDS,SARS4传染病学绪论华中科技大学同济医学院5传染病学绪论华中科技大学同济医学院The Incidence Rate of Communicable Diseases in ChinaThe Incidence Rate of Communicable Diseases in ChinaCurrent SituationCurrent Situation6传染病学绪论华中科技大学同济医学院The Proportion of Different Communicable The Proportion of Different Communicable Diseases by Etiology in China, 1950s-2002s Diseases by Etiology in China, 1950s-2002s Transmitted by sex or bloodGastrointestinalVector-borne and natural endemicRespiratoryRespiratory7传染病学绪论华中科技大学同济医学院Leading Causes of Death8传染病学绪论华中科技大学同济医学院9传染病学绪论华中科技大学同济医学院Reemerging Infectious Diseasen nWhy?n nHuman Demography and BehaviorHuman Demography and Behaviorn nTechnology and IndustryTechnology and Industryn nEconomic development and Land UseEconomic development and Land Usen nMicrobial Adaptation and ChangeMicrobial Adaptation and Changen nBreakdown of Public Health MeasuresBreakdown of Public Health Measuresn nand Deficiencies in Public Healthand Deficiencies in Public Health10传染病学绪论华中科技大学同济医学院Natural Environment Destroy11传染病学绪论华中科技大学同济医学院Infection and ImmunityinfectionimmunityBolus of infection x virulenceimmunityDisease =12传染病学绪论华中科技大学同济医学院Response to InfectioninfectionxdiseaseInnate immunityno diseaserecoveryadaptive immunityre-infectionno diseasex13传染病学绪论华中科技大学同济医学院 Infection spectrumPrimary InfectionRepeated InfectionMixed InfectionSuperinfectionSecondary Infection14传染病学绪论华中科技大学同济医学院InfectionInfectionPathogen eradicationOvert infectionClinical InfectionLatent infectionPathogen eradicationCarrierPatientColonizationColonizationCarrierCovert infectionSubclinical infectionBacteremia/viremiaClinical Outcomes of InfectionClinical Outcomes of Infection15传染病学绪论华中科技大学同济医学院Pathogenic effectiveness of Pathogenic effectiveness of micro-organismsmicro-organismsPathogenecityInvasiveness (colonization factor)Invasiveness (colonization factor)Virulence (exotoxin and endotoxin)Virulence (exotoxin and endotoxin)QuantityQuantityVariability (HBV mutation)Variability (HBV mutation)16传染病学绪论华中科技大学同济医学院ImmunityNonspecificimmunitySpecificimmunityNatural barrierPhagocytosisHumoral factorCellular immunitycomplementcytokinelysozymeHumoral immunityIgMIgAIgEIgGImmune Response in Infection ProcessImmune Response in Infection Process17传染病学绪论华中科技大学同济医学院Cells of the Immune Systemn nLeukocytes(NotAgspecific)Leukocytes(NotAgspecific)n nneutrophils(PMNs)neutrophils(PMNs)n nmonocyte/macrophagemonocyte/macrophagen neosinophileosinophiln nbasophilbasophiln nSpecializedcells(Agspecific)Specializedcells(Agspecific)n nB-cellsB-cellsantibodiesantibodiesn nT-cellsT-cells18传染病学绪论华中科技大学同济医学院T cells classification19传染病学绪论华中科技大学同济医学院How does the immune system work?MHCclassImoleculepresentinganepitopeMHCclassImoleculepresentinganepitopeMHCclassImoleculepresentinganepitopeMHCclassImoleculepresentinganepitopeMHCclassImoleculepresentinganepitopeMHCclassImoleculepresentinganepitope20传染病学绪论华中科技大学同济医学院Infection and Immune21传染病学绪论华中科技大学同济医学院Infection and Immune(herpes simplex)nInitialinfectionbyherpessimplexvirusintheskinisclearedbyaneffectiveimmuneresponse.nButresidualinfectionpersistsinsensoryneurons.nWhenthevirusisreactivated,theskinisre-infected.Thiscanberepeatedendlessly.22传染病学绪论华中科技大学同济医学院Pathogenesis of Infectious Disease23传染病学绪论华中科技大学同济医学院 Direct Injury Direct Injury Toxin ToxinHarmful Immune Harmful Immune responseresponseInvasionInvasionColonizationColonizationOutputOutputPathogenPathogenInjuryInjuryFeverFeverMetabolism disorderMetabolism disorderE Endocrine disturbanceDevelopment of infectious diseaseDevelopment of infectious diseaseInjury of cells and tissuesInjury of cells and tissuesDisorderofpathophysiologyDisorderofpathophysiology24传染病学绪论华中科技大学同济医学院n nAdhesinsAdhesinsn nCapsularmaterialCapsularmaterialn nProteins(ProteinF,ProteinM)Proteins(ProteinF,ProteinM)n nLipotechoicacidsLipotechoicacidsn nFimbriae&PiliFimbriae&Pilin nEndotoxinsEndotoxinsn nGramnegativeLPScellwallcomponents(LipidAandCoreGramnegativeLPScellwallcomponents(LipidAandCoreSugars)Sugars)n nExotoxinsExotoxinsn nCanbeproducedbyeitherGramPositiveorGramNegativeCanbeproducedbyeitherGramPositiveorGramNegativeOrganismsOrganismsCell and Tissue Damage Induced by Micro-organisms Bacteria25传染病学绪论华中科技大学同济医学院Cell and Tissue Damage Induced by Micro-organisms virusesn nDirectattachmentandkillingn nInhibithostcellsynthesis(RNA,DNA,proteins)n nIntracellularreplicationandlysisn nSurfacetargetsforhostimmunesystemn nLocaldirectdamageleadingtosecondarybacterialinfectionsn nLatentinjury26传染病学绪论华中科技大学同济医学院 Harmful Host Responses to Infectious Agentsn nAutoimmunity:Autoimmunity: break the rules of the “self-versus- break the rules of the “self-versus-nonself”. Direct against “self-proteins”nonself”. Direct against “self-proteins”n nHypersensitivity reactionsHypersensitivity reactions type I or immediate hypersensitivity (mast cell associated IgE)type I or immediate hypersensitivity (mast cell associated IgE) type II or cytotoxic hypersensitivity (antibody-complement type II or cytotoxic hypersensitivity (antibody-complement activation and natural killer) activation and natural killer) type III or immune-complex-mediated hypersensitivity type III or immune-complex-mediated hypersensitivity type IV or delayed-type hypersensitivity (activated T, CD8+, Mac) type IV or delayed-type hypersensitivity (activated T, CD8+, Mac) prolonged antigen exposure prolonged antigen exposure27传染病学绪论华中科技大学同济医学院Enterovirus Pathogeneis28传染病学绪论华中科技大学同济医学院Colonized herd29传染病学绪论华中科技大学同济医学院Epidemic Process30传染病学绪论华中科技大学同济医学院EpidemicProcessSourceofinfectionRouteoftransmissionSusceptiblepopulation31传染病学绪论华中科技大学同济医学院Why do people get sick?New pathogens or changes in New pathogens or changes in pathogens pathogens (HIV, Nile-like virus)(HIV, Nile-like virus)Changes in environmental conditionsChanges in environmental conditions(natural or man-made)(natural or man-made)Host FactorsHost Factors(Age, gender, ethnicity, immune status,(Age, gender, ethnicity, immune status,Nutritional status, behavior)Nutritional status, behavior)32传染病学绪论华中科技大学同济医学院Source of Infection n nPatientn nCovert infected personn nCarriern nInfected animal33传染病学绪论华中科技大学同济医学院Other effective factors:ClimateClimateTemperature,HumidityTemperature,HumiditySocietySocietySanitation,CulturalBackground,WarSanitation,CulturalBackground,War34传染病学绪论华中科技大学同济医学院Routes of Transmissionn nAir-borne, droplet infection,dustAir-borne, droplet infection,dustn nFomite borne (Fomite borne (污染物污染物污染物污染物): Water, food, flies): Water, food, fliesn nDirect contact of unclean hands and Direct contact of unclean hands and fingers, toysfingers, toysn nVector borneVector borne A) mechanical A) mechanical B) biological B) biological n nBlood and blood source productsBlood and blood source productsn nContact with soilContact with soiln nTransplacentalTransplacental35传染病学绪论华中科技大学同济医学院HIVs Transmission RoutesHIVs Transmission Routes36传染病学绪论华中科技大学同济医学院Susceptible Populationn nAgroupofpeopleatincreasedriskforinfectionandillnessfromapathogen,oftencausedbyadecreaseintheeffectivenessofthepersonsimmunesystem.37传染病学绪论华中科技大学同济医学院Chain of TransmissionPortal of exitPortal of entryAgentSusceptible HostMode of transmissionReservoirPerson to person transmission38传染病学绪论华中科技大学同济医学院AgentHostEnvironment Age Sex Genotype Behaviour Nutritional status Health status Infectivity Pathogenicity Virulence Immunogenicity Antigenic stability Survival Weather Housing Geography Occupational setting Air quality FoodFactors Influencing Disease Transmission39传染病学绪论华中科技大学同济医学院Distribution due to Socioeconomicn nHepatitis An nTyphoid fevern nHelicobacter pylorin nOther bacterial diarrheasn nTuberculosis40传染病学绪论华中科技大学同济医学院Characteristics of Infectious Diseases41传染病学绪论华中科技大学同济医学院n nPathogenn nInfectivity: isolation of patientsn nEpidemiologic feature: continue with next sliden nPost-infection immunityBasic featuresBasic features42传染病学绪论华中科技大学同济医学院 Level of Epidemicn nSporadicSporadic level level - -occasionalcasesoccurringatirregularintervalsoccasionalcasesoccurringatirregularintervals n nEndemic levelEndemic level - -persistentoccurrencewithalowtomoderatelevelpersistentoccurrencewithalowtomoderatelevel n nHHyperendemic levelyperendemic level - -persistentlyhighlevelofoccurrencepersistentlyhighlevelofoccurrencen nEpidemicEpidemic or outbreak or outbreak - -occurrenceclearlyinexcessoftheexpectedoccurrenceclearlyinexcessoftheexpectedlevelforagiventimeperiodlevelforagiventimeperiodn nPandemicPandemic - -epidemicspreadoverseveralcountriesorcontinents,epidemicspreadoverseveralcountriesorcontinents,affectingalargenumberofpeopleaffectingalargenumberofpeople43传染病学绪论华中科技大学同济医学院Clinical Phagen nIncubation period ( (潜伏期潜伏期潜伏期潜伏期) )n nProdromal period ( (前驱期前驱期前驱期前驱期) )n nManifestation period ( (症状期症状期症状期症状期) )n nRecovery phase ( (恢复期恢复期恢复期恢复期) )n nRelapse ( (复发复发复发复发): fully recover and disease re-appeares): fully recover and disease re-appearesn nRecrudescence ( (再燃再燃再燃再燃): not fully recovered and got worser): not fully recovered and got worsern nSequela ( (后遗症后遗症后遗症后遗症): functionally not fully recovered): functionally not fully recovered44传染病学绪论华中科技大学同济医学院 1. Effervescence (increasing) 1. Effervescence (increasing) 2. Fastigium (peaking) 2. Fastigium (peaking) 3. Defervescence (decreasing) 3. Defervescence (decreasing)Symptoms and signsFever Process45传染病学绪论华中科技大学同济医学院Symptoms and signsFever typesSustained Fever Remittent FeverIntermittent Fever (septic fever)Relapsing Fever (Undulant Fever)Saddle Type FeverIrregular Fever46传染病学绪论华中科技大学同济医学院Fever typeSustained Fever Remittent FeverIntermittent Fever (septic fever)Undulant FeverRelapsing FeverIrregular Fever47传染病学绪论华中科技大学同济医学院Skin EruptionMaculeMacule( (班疹班疹班疹班疹) )Maculo-papuleMaculo-papule( (班丘疹班丘疹班丘疹班丘疹) )RoseolaRoseola( (玫瑰疹玫瑰疹玫瑰疹玫瑰疹) )48传染病学绪论华中科技大学同济医学院Skin EruptionPetechiaePetechiae( (出血疹出血疹出血疹出血疹) )EcchymosisEcchymosisHerpesHerpesHerpes49传染病学绪论华中科技大学同济医学院The Time Rash Appears Day 1 Rubella (风疹风疹) Day 2 Scarlet Fever (猩红热猩红热) Day 3 Small Pox (天花天花) Day 5 Typhus Fever (班疹伤寒班疹伤寒) Day 6 Typhoid (伤寒伤寒)50传染病学绪论华中科技大学同济医学院Other SymptomsConjunctiva congestedConjunctiva congestedEnlargement of lymph nodes Enlargement of lymph nodes nnToxemicsymptomsToxemicsymptomsBleedingBleedingComaComannMononuclear-phagocyteMononuclear-phagocytesystemresponsesystemresponseSpleno-hepatomegalySpleno-hepatomegalySpleno-hepatomegaly51传染病学绪论华中科技大学同济医学院Diagnosisn n EpidemiologyEpidemiologyvitalandsignificantindiagnosisvitalandsignificantindiagnosisn n Clinical ManifestationClinical Manifestationsuchasroserash,splenohepatomegaly,gastrocnemiustendernesssuchasroserash,splenohepatomegaly,gastrocnemiustendernessn n Laboratory TestLaboratory Testmainmeansfordiagnosismainmeansfordiagnosis52传染病学绪论华中科技大学同济医学院Laboratory Testnn Light MicroscopyLight Microscopy H&EstainedsectionsH&EstainedsectionsSpecialStains:Gram,AcidFast,SpecialStains:Gram,AcidFast,GiemsaGiemsa nn CultureCulture Bacterial,Mycobacterial,Fungal,ViralBacterial,Mycobacterial,Fungal,Viralnn Immune TestImmune Test SerologicStudiesELISASerologicStudiesELISAImmunoperoxidaseStainsImmunoperoxidaseStainsDirectFluorescentAntibodiesDirectFluorescentAntibodiesnn Polymerase Chain ReactionPolymerase Chain Reaction53传染病学绪论华中科技大学同济医学院Treatmentn nGeneralandsupportingtreatmentGeneralandsupportingtreatmentn nHeteropathy(Heteropathy(对症治疗对症治疗) )n nPathogenicandspecifictreatmentPathogenicandspecifictreatmentn nRehabilitationtherapyRehabilitationtherapyn nTraditionalChineseMedicineandacupunctureTraditionalChineseMedicineandacupuncturetreatmenttreatment54传染病学绪论华中科技大学同济医学院Antibiotic Therapyn nProperdosen nPropertimeintervaln nProperrouteofadministration(oral,parenteral)n nCombinationantibiotictherapy55传染病学绪论华中科技大学同济医学院The main classes of antibiotics n nnAminoglycosidesAminoglycosidesAminoglycosidesn nnCephalosporinsCephalosporinsCephalosporinsn nnFluoroquinolonesFluoroquinolonesFluoroquinolonesn nnMacrolidesMacrolidesMacrolidesn nnPenicillinsPenicillinsPenicillinsn nnTetracyclinesTetracyclinesTetracyclines56传染病学绪论华中科技大学同济医学院Antibiotic Resistance57传染病学绪论华中科技大学同济医学院Antiviral Therapyn nInterferonn nNucleosideAnaloguesn nHigh Active Anti-Retroviral Therapy, HAART n nTreatHIV,HBV,HCVInterferonInterferonLamivudineLamivudine58传染病学绪论华中科技大学同济医学院Antiparasitic Drugs n nAntimalarial(Antimalarial(抗疟药抗疟药抗疟药抗疟药) )CHLOROQUINE(CHLOROQUINE(氯喹氯喹)n nAntiprotozoalDrugs(AntiprotozoalDrugs(抗原虫药抗原虫药抗原虫药抗原虫药) )Amebiasis(Amebiasis(阿米巴病阿米巴病阿米巴病阿米巴病)andTrichomonas()andTrichomonas(毛滴虫属毛滴虫属毛滴虫属毛滴虫属) )METRONIDAZOLE(METRONIDAZOLE(甲硝唑甲硝唑)n nFluke(Fluke(吸虫吸虫吸虫吸虫)andTapeworm()andTapeworm(绦虫绦虫绦虫绦虫)Infections)InfectionsSchistosomiasis(Schistosomiasis(血吸虫病血吸虫病血吸虫病血吸虫病) )PRAZIQUANTEL(PRAZIQUANTEL(吡喹酮吡喹酮) )n nFilariasis(Filariasis(丝虫病丝虫病丝虫病丝虫病) )diethylcarbamazine(diethylcarbamazine(乙胺嗪乙胺嗪) )n nIntestinalRoundworms(Ascaris),(IntestinalRoundworms(Ascaris),(线虫线虫线虫线虫, ,蛔虫蛔虫蛔虫蛔虫) )Enterobius(Pinworm)(Enterobius(Pinworm)(蛲虫蛲虫蛲虫蛲虫)andHookworm()andHookworm(钩虫钩虫钩虫钩虫) )Albendazole(Albendazole(丙硫咪唑丙硫咪唑) )59传染病学绪论华中科技大学同济医学院Prophylaxisn nSanitationn nwaterandwastetreatmentwaterandwastetreatmentn npersonalhygienepersonalhygienen nVaccinationn nprobablythebestwaytopreventcommunicablediseasesprobablythebestwaytopreventcommunicablediseasesn nHealthylivingn npracticesafesexpracticesafesexn navoiddrugsavoiddrugsn nAntibioticsandotherdrugs60传染病学绪论华中科技大学同济医学院Prophylaxis61传染病学绪论华中科技大学同济医学院Law of the peoples Republic of China on Law of the peoples Republic of China on Prevention and Treatment of Infections DiseasesPrevention and Treatment of Infections Diseases n nArticle 3TheinfectiousdiseasesgovernedbythisLawaredividedintoClassesA，BandC.n nInfectious diseases under Class A are plague and cholera. 62传染病学绪论华中科技大学同济医学院Law of the peoples Republic of China on Law of the peoples Republic of China on Prevention and Treatment of Infections DiseasesPrevention and Treatment of Infections Diseasesn nInfectious diseases under Infectious diseases under Class BClass B are infectious SARS are infectious SARS， AIDSAIDS， viral hepatitis, poliomyelitisviral hepatitis, poliomyelitis， highly pathogenic highly pathogenic avian influenzaavian influenza， measlesmeasles， epidemic hemorrhagic feverepidemic hemorrhagic fever， rabies epidemic encephalitis Brabies epidemic encephalitis B， dengue feverdengue fever， anthraxanthrax， bacillary and amebic dysenterybacillary and amebic dysentery， pulmonary tuberculosispulmonary tuberculosis， typhoid and paratyphoidtyphoid and paratyphoid， epidemic cerebrospinal meningitisepidemic cerebrospinal meningitis， pertussispertussis， diphtheriadiphtheria， tetanus infantumtetanus infantum， scarlet feverscarlet fever， brucellosisbrucellosis， gonorrhoeagonorrhoea， syphilissyphilis， leptospirosisleptospirosis， schistosomiasis and malaria. schistosomiasis and malaria. 63传染病学绪论华中科技大学同济医学院Law of the peoples Republic of China on Law of the peoples Republic of China on Prevention and Treatment of Infections DiseasesPrevention and Treatment of Infections Diseasesn nInfectious diseases under Class CClass C are influenza，epidemic parotitis，rubella，acute hemorrhagic conjunctivitis，leprosy epidemic and endemic typhus，kala-azar，echinococcosis，filariasis，and infectious diarrhea other than cholera，bacillary and amebic dysentery，typhoid and paratyphoid. 64传染病学绪论华中科技大学同济医学院Law of the peoples Republic of China on Law of the peoples Republic of China on Prevention and Treatment of Infections DiseasesPrevention and Treatment of Infections Diseasesn nArticle 30Article 30 When disease prevention and control institutions When disease prevention and control institutions， medical agenciesmedical agencies， blood collectors and supplies or their staff blood collectors and supplies or their staff members on duty find the epidemic situation of infectious members on duty find the epidemic situation of infectious diseases or the this Law or the outbreak and prevalence of diseases or the this Law or the outbreak and prevalence of other infectious diseases or the infectious diseases the causes other infectious diseases or the infectious diseases the causes for the sudden outbreak of which are uncertainfor the sudden outbreak of which are uncertain， they shall they shall report in adherence to the principle of territorial control in report in adherence to the principle of territorial control in respect of report on epidemic situation and in accordance with respect of report on epidemic situation and in accordance with the contentsthe contents， procedureprocedure， from and time limit prescribed by from and time limit prescribed by the State Council or by the health administration department the State Council or by the health administration department under the State Council.under the State Council.65传染病学绪论华中科技大学同济医学院Brief Reviewn nWhat is an Infectious Disease?n nCurrent Situationn nPathogenesisn nEpidemiologyn nClinical Manifestationn nDiagnosisn nTreatment66传染病学绪论华中科技大学同济医学院Perferences1. 1.PaulD.Hoeprich,M.colinJordan,AllanR.RonaldInfectiousDiseases.J.B.PaulD.Hoeprich,M.colinJordan,AllanR.RonaldInfectiousDiseases.J.B.LippincoottCompany.Philadelphia1994.LippincoottCompany.Philadelphia1994.2. 2.VallejoM,MolinaA,MosqueraJ,etal.EarlyHospitalMortalityduetoinfectiousVallejoM,MolinaA,MosqueraJ,etal.EarlyHospitalMortalityduetoinfectiousdiseases.AnMedInterna.2003Jul;20(7):347-350.diseases.AnMedInterna.2003Jul;20(7):347-350.3. 3. TarasevichIV,ShaginyanIA,MediannikovOY.ProblemsandperspectivesofTarasevichIV,ShaginyanIA,MediannikovOY.Problemsandperspectivesofmolecularepidemiologyofinfectiousdiseases.AnnNYAcadSci.2003molecularepidemiologyofinfectiousdiseases.AnnNYAcadSci.2003Jun;990:751-6.Jun;990:751-6.4. 4.CornelisGR.Bacterialinfectiousdiseases.Arejuvenatedfield.Cell.2003JulCornelisGR.Bacterialinfectiousdiseases.Arejuvenatedfield.Cell.2003Jul11;114(1):12-3.11;114(1):12-3.5. 5.MouthonL,LortholaryO.Intravenousimmunoglobulinsininfectiousdiseases:MouthonL,LortholaryO.Intravenousimmunoglobulinsininfectiousdiseases:wheredowestand?ClinMicrobiolInfect.2003May;9(5):333-8.wheredowestand?ClinMicrobiolInfect.2003May;9(5):333-8.6. 6.EnserinkM.Infectiousdiseases.U.S.monkeypoxoutbreaktracedtoWisconsinpetEnserinkM.Infectiousdiseases.U.S.monkeypoxoutbreaktracedtoWisconsinpetdealer.Science.200313;300:1639.dealer.Science.200313;300:1639.67传染病学绪论华中科技大学同济医学院973重大项目重大项目 NSFC杰出青年和青年基金杰出青年和青年基金 国际核心期刊论文国际核心期刊论文 优秀博士生论文优秀博士生论文韩梅芳韩梅芳严伟明严伟明习习 东东68传染病学绪论华中科技大学同济医学院Thanks for Your Attention!69传染病学绪论华中科技大学同济医学院